Provider Demographics
NPI:1912293317
Name:MOINUDDIN, SADIA FATIMA (MD)
Entity Type:Individual
Prefix:
First Name:SADIA
Middle Name:FATIMA
Last Name:MOINUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8816 FOOTHILL BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7199
Mailing Address - Country:US
Mailing Address - Phone:909-579-6753
Mailing Address - Fax:
Practice Address - Street 1:901 SAN BERNARDINO RD STE 101
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-7299
Practice Address - Country:US
Practice Address - Phone:909-579-6753
Practice Address - Fax:909-694-1045
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR72494OtherTRAINING PERMIT